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           a recent study stressed the role of tryptophan (a serotonin   2000;36:1134-41.
           precursor) depletion  in developing CRF and found a   7.   Kyrdalen AE, Dahl AA, Hernes E, Hem E, Fossa SD. Fatigue in prostate
           correlation  between  the  higher  degree  of fatigue  and   cancer survivors treated with definitive radiotherapy and LHRH analogs.
           lower tryptophan  concentrations.  Thus, a drug that  acts   8.   Prostate 2010;70:1480-9.
                                                                 Capuron L, Miller  AH. Immune system to brain signalling:
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                        [12]
           modafinil  action  has  not  been  elucidated,  it  seems  to   in randomized double-blind clinical trials of agents for the therapy for
           rely  on the  interaction  of adrenergic  and  dopaminergic   fatigue in patients with advanced cancer. Cancer 2010;116:766-74.
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                                                                 review and meta-analysis of the pharmacological treatment of cancer-
           could facilitate excitatory  synaptic  signaling, mainly   related fatigue. J Natl Cancer Inst 2008;20:1155-66.
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                                                                 treatment of cancer-related fatigue. Oncologist 2007;12:43-51.
           Considering these data, the use of a drug like duloxetine,   13.  Morrow GR, Hickok JT, Roscoe JA, Raubertas RF,  Andrews PL,
                                                                 Flynn PJ, Hynes HE, Banerjee TK, Kirshner JJ, King DK, University
           that has a  pleiotropic action  on these pathways, has some   of Rochester Cancer Center Community Clinical Oncology Program.
           rationale  in the treatment  of CRF. Moreover,  in our case,   Differential effects  of  paroxetine  on  fatigue  and  depression:  a
           further  benefit  was  derived  from  its  activity  on urinary   randomized, double-blind trial from the University of Rochester
           incontinence,  thus  promoting  the  patient’s  sense of  well-  Cancer Center Community Clinical Oncology Program. J Clin Oncol
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                                                                 Blonna D. Fibromyalgia syndrome: etiology, pathogenesis, diagnosis and
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           In conclusion, a pilot placebo-controlled trial using   2011;50:281-94.
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           Financial support and sponsorship                     Casteren NJ, Cornford P, Joniau S, Mason MD, Matveev V, van der
           Nil.                                                  Kwast TH, van der Poel H, Rouvière O, Wiegel T. Guidelines on Prostate
                                                                 Cancer, European Association of Urology; 2014. Available from: http://
           Conflicts of interest                                 www.uroweb.org/wp-content/ uploads/1607-Prostate-Cancer_LRV3.pdf.
           There are no conflicts of interest.                    [Last accessed on 2015 Aug 14].
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                                                                 SE, Bushunow P, Qazi R, Smith B. Effect of paroxetine hydrochloride
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